Type 2 diabetes intervention proves helpful

Among overweight adults, participation in an intensive lifestyle intervention was associated with a greater likelihood of partial remission of type 2 diabetes, but the absolute remission rates were modest, according to a study.

Diabetes traditionally has been considered a progressive, incurable condition wherein the best-case scenario after diagnosis is tight metabolic and risk factor management to forestall vascular and neuropathic complications, according to background information in the article, which appeared in the Dec. 19 issue of the Journal of the American Medical Association.

Patients diagnosed as having type 2 diabetes frequently ask their physicians whether their condition is reversible, and some physicians may provide hopeful advice that lifestyle change can normalize glucose levels. However, the rate of remission of type 2 diabetes that may be achieved using non-surgical approaches has not been reported.

Edward W. Gregg, PhD, of the Centers for Disease Control and Prevention in Atlanta, and colleagues conducted a study to examine the association of an intensive lifestyle intervention with frequency of partial and complete remission of type 2 diabetes. The study consisted of an ancillary observational analysis of a four-year randomized controlled trial comparing an intensive lifestyle intervention with a diabetes support and education program. The study included 4,503 U.S. adults with body mass index of 25 or higher and type 2 diabetes.

Participants were randomly assigned to receive the intensive lifestyle intervention (ILI), which included weekly group and individual counseling in the first six months followed by three sessions per month for the second six months and twice-monthly contact and regular refresher group series and campaigns in the second through fourth years; or diabetes support and education (DSE), an offer of three group sessions per year on diet, physical activity and social support. The ILI aimed to reduce net caloric intake to 1,200 to 1,800 calories a day through reductions in total and saturated fat intake and by increasing physical activity levels to a goal of 175 minutes per week. Liquid meal replacements were provided to assist dietary goals.

Participants in the ILI group had lost significantly more weight than DSE participants at both year one (-8.6% vs. -0.7%) and year four (-4.7% vs. -0.8%) and had greater increases in fitness at both year one (20.6% vs. 5.3%) and year four (4.9% vs. -1.5%).

The researchers also found that the prevalence of complete remission (i.e., glucose normalization without medication) was more common in the ILI group than in the DSE group across all years of the study. However, the absolute prevalence was low, ranging from 1.3% for ILI vs. 0.1% for DSE in year one, to 0.7% for ILI vs. 0.2% for DSE in year four.

Additional analyses indicated that ILI participants were significantly more likely to experience any remission, partial or complete, with a prevalence of 11.5% during the first year, decreasing to 7.3% during year four, compared with 2% in the DSE group at both points. Rates of any remission were notably higher (15% to 21%) among people with substantial weight loss or fitness change, shorter duration of extant diabetes or a lower HbA1c level at entry and those not using insulin.

The authors wrote that the ILI group was significantly more likely to have continuous, sustained remission, with 9.2% experiencing at least a two-year remission at some point during follow-up versus 1.7% of the DSE group; and 6.4% experiencing at least a three-year remission versus 0.5% in the DSE group. The results from the complete case analyses were similar, they wrote.

The increasing worldwide prevalence of type 2 diabetes, along with its wide-ranging complications, has led to hopes that the disease can be reversed or prevented. These analyses of more than 4,500 overweight adults with type 2 diabetes confirm that complete remission associated with an intensive lifestyle intervention, when defined by glucose normalization without need for drugs, is rare.

However, partial remission, defined as a transition to prediabetic or normal glucose levels without drug treatment for a specific period, is an obtainable goal for some patients with type 2 diabetes.

The study abstract is available at http://jama.jamanetwork.com/article.aspx?articleid=1486829.

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